IntroductionThe objective of this study was to investigate regional organ perfusion acutely following uncontrolled hemorrhage in an animal model that simulates a penetrating vascular injury and accounts for prehospital times in urban trauma. We set forth to determine if hypotensive resuscitation (permissive hypotension) would result in equivalent organ perfusion compared to normotensive resuscitation.MethodsTwenty four (n=24) male rats randomized to 4 groups: Sham, No Fluid (NF), Permissive Hypotension (PH) (60% of baseline mean arterial pressure - MAP), Normotensive Resuscitation (NBP). Uncontrolled hemorrhage caused by a standardised injury to the abdominal aorta; MAP was monitored continuously and lactated Ringer’s was infused. Fluorimeter readings of regional blood flow of the brain, heart, lung, kidney, liver, and bowel were obtained at baseline and 85 minutes after hemorrhage, as well as, cardiac output, lactic acid, and laboratory tests; intra-abdominal blood loss was assessed. Analysis of variance was used for comparison.ResultsIntra-abdominal blood loss was higher in NBP group, as well as, lower hematocrit and hemoglobin levels. No statistical differences in perfusion of any organ between PH and NBP groups. No statistical difference in cardiac output between PH and NBP groups, as well as, in lactic acid levels between PH and NBP. NF group had significantly higher lactic acidosis and had significantly lower organ perfusion.ConclusionsHypotensive resuscitation causes less intra-abdominal bleeding than normotensive resuscitation and concurrently maintains equivalent organ perfusion. No fluid resuscitation reduces intra-abdominal bleeding but also significantly reduces organ perfusion.

PH reduced bleeding and improved hemostasis compared with normotensive resuscitation. DDAVP given preshock exerted similar effects with normotensive resuscitation.

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A injeção de silicone líquido industrial nas mamas é um procedimento ilícito e que pode desencadear manifestações clínicas locais e sistêmicas de elevada gravidade para o paciente. As mulheres e indivíduos transgêneros correspondem às principais vítimas, podendo evoluir com: nodulações dolorosas, migração à distância, resposta inflamatória, ulceração, embolização e óbito. Embora não seja possível estabelecer uma relação causal entre a presença de siliconoma e o desenvolvimento de câncer de mama, estudos de imagem e histopatológicos podem não identificar com clareza um eventual tumor de origem neoplásica concomitante. Atualmente, não há protocolos de abordagem do siliconoma, porém, recomenda-se a ressecção cirúrgica quando possível, sendo geralmente necessária mastectomia simples seguida de reconstrução imediata. Reabordagens cirúrgicas podem ser necessárias para tratamento de complicações associadas. O presente trabalho apresenta um relato de caso de injeção de silicone líquido industrial nas mamas, realizado por esteticista, com repercussões locais severas para a paciente, e cujo tratamento envolveu procedimentos cirúrgicos secundários e acompanhamento por equipe multidisciplinar.

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Epigastric hernias are defined as defects in the abdominal midline between the navel and the xiphoid process. Incarceration and strangulation are rare. This is a case report, the purpose of this article is to report a case of acute appendicitis successfully treated in an incarcerated epigastric hernia at the Santa Casa de Misericórdia Hospital in Belo Horizonte, correlating with the current literature. It is not yet clear how the cecum and appendix can mobilize freely to the epigastric region and present within the sac of an epigastric hernia. It has been suggested that in 10% of the population, there may be anatomical variation and abnormal mobility of the cecum, referred to as mobile cecal syndrome. However, it is difficult to establish which pathophysiological process (or perhaps both) could have attributed to this rare presentation.

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